Provider Demographics
NPI:1154721744
Name:MEEHAN, JENNIFER (EDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVER BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8630
Mailing Address - Country:US
Mailing Address - Phone:803-476-4100
Mailing Address - Fax:
Practice Address - Street 1:1 RIVER BOTTOM RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8630
Practice Address - Country:US
Practice Address - Phone:803-476-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC258455103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool